Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

Evaluation of 1031 primary titanium nitride coated mobile bearing total knee arthroplasties in an orthopedic clinic

AIM To evaluate the influence of the titanium nitride(TiN) coating on the results of a total knee arthroplasty(TKA). METHODS A total of 910 patients(338 men; 572 woman), with a mean age of 65(range 36-94) undergoing 1031 primary TKAs were assessed. Clinical evaluation and patientreported outcomes were gathered one year after surgery. The questionnaires included the Knee injury and Osteoarthritis Outcome Score(KOOS)-Dutch version, Visual Analogue Scale(VAS) pain scores in rest and during active knee movement, VAS-satisfaction scores, and EQ-5 D-3 L health scores. This was aimed to assess the overall knee function and patient satisfaction, and to enable us to make a gross comparison to other TKAs.RESULTS At a mean follow-up of 46 mo(range 1-92) the overall implant survival was 97.7% and 95.1% for any operative reason related to the implant. Twenty-three knees(2.2%) required revision surgery. Arthrofibrosis was the most common indication for a re-operation. The clinical evaluation and patient-reported outcomes revealed good to excellent patient satisfaction and function of the arthroplasty. The median postoperative VAS-pain scores on a scale of 0-100, at one year after surgery were 1 in rest and 2 during movement.CONCLUSION The Ti N coated, mobile bearing TKA results are excellent and similar to those of other widely used TKA designs. Residual pain of the knee remains a concern and the Ti N coating in combination with the mobile bearing does not seem to be the simple solution to this problem. Future research will have to show that the coating gives a better survival than the cobalt chrome version.

Quercetin ameliorates oxidative stress-induced senescence in rat nucleus pulposus-derived mesenchymal stem cells via the miR-34a-5p/SIRT1 axis

BACKGROUND Intervertebral disc degeneration(IDD)is a main contributor to low back pain.Oxidative stress,which is highly associated with the progression of IDD,increases senescence of nucleus pulposus-derived mesenchymal stem cells(NPMSCs)and weakens the differentiation ability of NPMSCs in degenerated intervertebral discs(IVDs).Quercetin(Que)has been demonstrated to reduce oxidative stress in diverse degenerative diseases.AIM To investigate the role of Que in oxidative stress-induced NPMSC damage and to elucidate the underlying mechanism.METHODS In vitro,NPMSCs were isolated from rat tails.Senescence-associatedβ-galactosidase(SA-β-Gal)staining,cell cycle,reactive oxygen species(ROS),realtime quantitative polymerase chain reaction(RT-qPCR),immunofluorescence,and western blot analyses were used to evaluated the protective effects of Que.Meanwhile the relationship between miR-34a-5p and Sirtuins 1(SIRT1)was evaluated by dual-luciferase reporter assay.To explore whether Que modulates tert-butyl hydroperoxide(TBHP)-induced senescence of NPMSCs via the miR-34a-5p/SIRT1 pathway,we used adenovirus vectors to overexpress and downregulate the expression of miR-34a-5p and used SIRT1 siRNA to knockdown SIRT1 expression.In vivo,a puncture-induced rat IDD model was constructed,and X rays and histological analysis were used to assess whether Que could alleviate IDD in vivo.RESULTS We found that TBHP can cause NPMSCs senescence changes,such as reduced cell proliferation ability,increased SA-β-Gal activity,cell cycle arrest,the accumulation of ROS,and increased expression of senescence-related proteins.While abovementioned senescence indicators were significantly alleviated by Que treatment.Que decreased the expression levels of senescence-related proteins(p16,p21,and p53)and senescence-associated secreted phenotype(SASP),including IL-1β,IL-6,and MMP-13,and it increased the expression of SIRT1.In addition,the protective effects of Que on cell senescence were partially reversed by miR-34a-5p overexpression and SIRT1 knockdown.In vivo,X-ray,and histological analyses indicated that Que alleviated IDD in a punctureinduced rat model.CONCLUSION In summary,the present study provides evidence that Que reduces oxidative stress-induced senescence of NPMSCs via the miR-34a/SIRT1 signaling pathway,suggesting that Que may be a potential agent for the treatment of IDD.

动态^(18)F-FDG PET定量分析用于骨病变鉴别诊断

目的 评价18F 脱氧葡萄糖 (FDG)PET在骨骼病变中的诊断价值。方法 研究对象为40例原发性骨骼病变患者。所有患者在注射示踪剂后立即开始动态PET采集 ,持续 6 0min。对动态PET图像进行半定量分析 ,分别计算平均和最大标准摄取值 (SUVaver和SUVmax) ,病灶SUV/肌肉SUV比值 (T/M) ,病灶 6 0minSUV/ 30minSUV比值 (SUVaver 60 /3 0min和SUVmax 60 /3 0min)等。采用Patlak作图分析法对动态图像数据进行拟合计算 ,得出摄入常数 (Ki) ,计算FDG代谢率 (MRFDG)。根据接受器工作特性曲线 (ROC)确定各定量指标的诊断阈值 ,并比较其鉴别良恶性病变的灵敏度和特异性。结果 经病理检查证实恶性病变 2 1例 ,良性病变 19例。恶性病变的MRFDG和SUV值高于良性病变 ,但各种指标的数值分布均存在交叉重叠。SUVaver与MRFDG呈正相关 (r=0 6 7)。以SUV值≥ 1 8作为阈值时 ,鉴别良恶性病变的灵敏度和特异性分别为 85 0 %和 82 4% ,以MRFDG(1 1)为阈值时的灵敏度 (82 4% )与SUV相近 ,而特异性 (92 9% )较高。同时采用SUV(1 8)和SUVaver 60 /3 0min(1 1)作为鉴别标准时 ,较之单独采用SUV特异性可改善为 93 3% ,灵敏度略有降低 (81 3% )。结论 骨骼良恶性病变之间存在葡萄糖代谢率差异。单用静态FDGPET获取SUV值不能很好鉴?

人工全膝关节置换术截骨测量(英文)

[目的]作者对人工全膝关节置换术中股骨截骨方法进行了改良,增加了股骨后髁截骨厚度,本项研究通过截骨厚度的测量对改良截骨方法的手术效果进行了验证。[方法]对81例人工全膝关节置换术中的各向截骨骨块的厚度进行了测量,分为膝内翻和膝外翻两组,采用Student's t-test对截骨厚度和假体厚度进行了比较。[结果]总体截骨厚度在膝间隙和伸膝间隙均小于假体厚度。膝内翻组,外侧屈膝间隙存在微量的过度截骨;膝外翻组,内侧屈膝间隙存在微量的过度截骨。[结论]采用改良的股骨截骨方法,手术效果良好。

Anterior knee pain after a total knee arthroplasty: What can cause this pain?

Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis,and yet approximately 5%-10%of patients experience residual pain,especially in the anterior part of the knee.Many theories have been proposed to explain the etiology of this anterior knee pain(AKP)but,despite improvements having been made,AKP remains a problem.AKP can be described as retropatellar or peripatellar pain,which limits patients in their everyday lives.Patients suffering from AKP experience difficulty in standing up from a chair,walking up and down stairs and riding a bicycle.The question asked was:"How can a‘perfectly’placed total knee arthroplasty(TKA)still be painful:what can cause this pain?".To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain.Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA.This article is a review of what pain is,how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty.

Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: A systematic review with meta-analysis

BACKGROUND Diarrhea is a major infectious cause of childhood morbidity and mortality worldwide.In clinical trials,Lactobacillus rhamnosus GG ATCC 53013(LGG)has been used to treat diarrhea.However,recent randomized controlled trials(RCTs)found no evidence of a beneficial effect of LGG treatment.AIM To evaluate the efficacy of LGG in treating acute diarrhea in children.METHODS The EMBASE,MEDLINE,PubMed,Web of Science databases,and the Cochrane Central Register of Controlled Trials were searched up to April 2019 for metaanalyses and RCTs.The Cochrane Review Manager was used to analyze the relevant data.RESULTS Nineteen RCTs met the inclusion criteria and showed that compared with the control group,LGG administration notably reduced the diarrhea duration[mean difference(MD)-24.02 h,95%confidence interval(CI)(-36.58,-11.45)].More effective results were detected at a high dose≥1010 CFU per day[MD-22.56 h,95%CI(-36.41,-8.72)]vs a lower dose.A similar reduction was found in Asian and European patients[MD-24.42 h,95%CI(-47.01,-1.82);MD-32.02 h,95%CI(-49.26,-14.79),respectively].A reduced duration of diarrhea was confirmed in LGG participants with diarrhea for less than 3 d at enrollment[MD-15.83 h,95%CI(-20.68,-10.98)].High-dose LGG effectively reduced the duration of rotavirus-induced diarrhea[MD-31.05 h,95%CI(-50.31,-11.80)]and the stool number per day[MD-1.08,95%CI(-1.87,-0.28)].CONCLUSION High-dose LGG therapy reduces the duration of diarrhea and the stool number per day.Intervention at the early stage is recommended.Future trials are expected to verify the effectiveness of LGG treatment.

Insights of stem cell-based endogenous repair of intervertebral disc degeneration

Low back pain has become more prevalent in recent years,causing enormous economic burden for society and government.Common therapies used in clinics including conservative treatment and surgery can only relieve pain.Subsequent cell-based treatment such as mesenchymal stem cell transplantation poses problems such as short duration of therapeutic effect and tumorigenesis.Recently,the discovery and identification of stem cell niche and stem/progenitor cells in intervertebral disc bring increased attention to endogenous repair strategy.Therefore,we review the studies involving endogenous repair strategy and present the characteristics and current status of this treatment.Meanwhile,we also discuss the strategy and perspective of endogenous repair strategy in future.

Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery

Enhanced recovery after surgery(ERAS)protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team.ERAS pathways include pre-operative patient counselling,regional anesthesia and analgesia techniques,post-operative pain management,early mobilization and early feeding.Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty,compared with those who followed a traditional care approach.ERAS protocols reduce post-operative stress,contribute to rapid recovery,shorten length of stay(LOS)without increasing the complications or readmissions,improve patient satisfaction and decrease the hospital costs.We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement.These programs require good organization and handling by the multidisciplinary team.ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment.The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis,with a view to improving the surgical outcomes.

Knee biomechanics of patients with total knee replacement during downhill walking on different slopes

Purpose:The purpose of this study was to compare knee biomechanics of the replaced limb to the non-replaced limb of total knee replacement(TKR)patients and healthy controls during walking on level ground and on decline surfaces of 5°,10°,and 15°.Methods:Twenty-five TKR patients and 10 healthy controls performed 5 walking trials on different decline slopes on a force platform and an instrumented ramp system.Two analyses of variance,2×2(limb×group)and 2×4(limb×decline slope),were used to examine selected biomechanics variables.Results:The replaced limb of TKR patients had lower peak loading-response and push-off knee extension moment than the non-replaced and the matched limb of healthy controls.No differences were found in loading-response and push-off knee internal abduction moments among replaced,non-replaced,and matched limb of healthy controls.The knee flexion range of motion,peak loading-response vertical ground reaction force,and peak knee extension moment increased across all slope comparisons between 0°and 15°in both the replaced and non-replaced limb of TKR patients.Conclusion:Downhill walking may not be appropriate to include in early stage rehabilitation exercise protocols for TKR patients.

6-gingerol protects nucleus pulposus-derived mesenchymal stem cells from oxidative injury by activating autophagy

BACKGROUND To date,there has been no effective treatment for intervertebral disc degeneration(IDD).Nucleus pulposus-derived mesenchymal stem cells(NPMSCs)showed encouraging results in IDD treatment,but the overexpression of reactive oxygen species(ROS)impaired the endogenous repair abilities of NPMSCs.6-gingerol(6-GIN)is an antioxidant and anti-inflammatory reagent that might protect NPMSCs from injury.AIM To investigate the effect of 6-GIN on NPMSCs under oxidative conditions and the potential mechanism.METHODS The cholecystokinin-8 assay was used to evaluate the cytotoxicity of hydrogen peroxide and the protective effects of 6-GIN.ROS levels were measured by 2´7´-dichlorofluorescin diacetate analysis.Matrix metalloproteinase(MMP)was detected by the tetraethylbenzimidazolylcarbocyanine iodide assay.TUNEL assay and Annexin V/PI double-staining were used to determine the apoptosis rate.Additionally,autophagy-related proteins(Beclin-1,LC-3,and p62),apoptosisassociated proteins(Bcl-2,Bax,and caspase-3),and PI3K/Akt signaling pathwayrelated proteins(PI3K and Akt)were evaluated by Western blot analysis.Autophagosomes were detected by transmission electron microscopy in NPMSCs.LC-3 was also detected by immunofluorescence.The mRNA expression of collagen II and aggrecan was evaluated by real-time polymerase chain reaction(RT-PCR),and the changes in collagen II and MMP-13 expression were verified through an immunofluorescence assay.RESULTS 6-GIN exhibited protective effects against hydrogen peroxide-induced injury in NPMSCs,decreased hydrogen peroxide-induced intracellular ROS levels,and inhibited cell apoptosis.6-GIN could increase Bcl-2 expression and decrease Bax and caspase-3 expression.The MMP,Annexin V-FITC/PI flow cytometry and TUNEL assay results further confirmed that 6-GIN treatment significantly inhibited NPMSC apoptosis induced by hydrogen peroxide.6-GIN treatment promoted extracellular matrix(ECM)expression by reducing the oxidative stress injury-induced increase in MMP-13 expression.6-GIN activated autophagy by increasing the expression of autophagy-related markers(Beclin-1 and LC-3)and decreasing the expression of p62.Autophagosomes were visualized by transmission electron microscopy.Pretreatment with 3-MA and BAF further confirmed that 6-GIN-mediated stimulation of autophagy did not reduce autophagosome turnover but increased autophagic flux.The PI3K/Akt pathway was also found to be activated by 6-GIN.6-GIN inhibited NPMSC apoptosis and ECM degeneration,in which autophagy and the PI3K/Akt pathway were involved.CONCLUSION 6-GIN efficiently decreases ROS levels,attenuates hydrogen peroxide-induced NPMSCs apoptosis,and protects the ECM from degeneration.6-GIN is a promising candidate for treating IDD.

Elasticity of the Coracoacromial Ligament in Shoulders with Rotator Cuff Tears: Measurement with Ultrasound Elastography

Background: The symptoms of rotator cuff tear vary and may even be absent. Thus, the symptoms cannot be explained solely by the presence of rotator cuff tear, and other factors are thought to be involved. Because the rotator cuff comes in contact with the coracoacromial ligament, the elasticity of the ligament may be a factor of the symptoms. The purpose of this study was to clarify the elasticity of the coracoacromial ligament in live shoulders with rotator cuff tears. Methods: Forty-one shoulders in 24 persons were enrolled in this study. The average age was 52 years old (range, 15 - 84 years old). We investigated the presence of rotator cuff tear and measured the elasticity of the coracoacromial ligament by ultrasound elastography (EUB-7500, HITACHI, Japan). Ultrasound elastography was a useful method to quantify the strain of soft tissue when pressure was added. The strain ratio (the ratio of strain of the coracoacromial ligament to that of the rotator cuff) was used as the index of the elasticity of coracoacromial ligament. Thus, the higher the strain ratio was, the softer the ligament was. Results: The strain ratio of the coracoacromial ligaments without rotator cuff tear showed a negative correlation to the age (r = ﹣0.825, P 0.01). The strain ratio of the ligaments with rotator cuff tear (23.75 ± 15.05, 69.6 years old) was higher than that of the older ligaments without cuff tear (12.62 ± 7.94, 64.6 years old) (P = 0.0486). In shoulders with rotator cuff tear, the strain ratio of the ligaments with pain (14.37 ± 10.15, 66.7 years old) was lower than that of ligaments without pain (33.12 ± 13.59, 69.1 years old) (P = 0.0221). Conclusions: The coracoacromial ligament became stiffened with aging but softened with the existence of rotator cuff tear. The ligaments with symptomatic cuff tear are more stiffened than the ligaments with asymptomatic cuff tear.

Urolithin a alleviates oxidative stress-induced senescence in nucleus pulposus-derived mesenchymal stem cells through SIRT1/PGC-1α pathway

BACKGROUND In degenerative intervertebral disc(IVD),an unfavorable IVD environment leads to increased senescence of nucleus pulposus(NP)-derived mesenchymal stem cells(NPMSCs)and the inability to complete the differentiation from NPMSCs to NP cells,leading to further aggravation of IVD degeneration(IDD).Urolithin A(UA)has been proven to have obvious effects in delaying cell senescence and resisting oxidative stress.AIM To explore whether UA can alleviate NPMSCs senescence and to elucidate the underlying mechanism.METHODS In vitro,we harvested NPMSCs from rat tails,and divided NPMSCs into four groups:the control group,H2O2 group,H2O2+UA group,and H2O2+UA+SR-18292 group.Senescence-associatedβ-Galactosidase(SA-β-Gal)activity,cell cycle,cell proliferation ability,and the expression of senescence-related and silent information regulator of transcription 1/PPAR gamma coactivator-1α(SIRT1/PGC-1α)pathway-related proteins and mRNA were used to evaluate the protective effects of UA.In vivo,an animal model of IDD was constructed,and Xrays,magnetic resonance imaging,and histological analysis were used to assess whether UA could alleviate IDD in vivo.RESULTS We found that H2O2 can cause NPMSCs senescence changes,such as cell cycle arrest,reduced cell proliferation ability,increased SA-β-Gal activity,and increased expression of senescence-related proteins and mRNA.After UA pretreatment,the abovementioned senescence indicators were significantly alleviated.To further demonstrate the mechanism of UA,we evaluated the mitochondrial membrane potential and the SIRT1/PGC-1αpathway that regulates mitochondrial function.UA protected mitochondrial function and delayed NPMSCs senescence by activating the SIRT1/PGC-1αpathway.In vivo,we found that UA treatment alleviated an animal model of IDD by assessing the disc height index,Pfirrmann grade and the histological score.CONCLUSION In summary,UA could activate the SIRT1/PGC-1αsignaling pathway to protect mitochondrial function and alleviate cell senescence and IDD in vivo and vitro.

Titanium allergy or not? “Impurity” of titanium implant materials

For patients suffering from allergies to nickel, chrome and cobalt, titanium implants are the implants of choice. Nevertheless, titanium implant sensitivity has been reported in the form of “allergies” and an increasing number of patients are confused. This paper aims to use spectral analysis as a diagnostic tool for analyzing different titanium implant alloys in order to determine the percentage of the alloy components and additions that are known to cause allergies. Different materials, such as sponge titanium, TiAl6Nb7, Ti21SRx, TiAl6V4 [forged alloy], TiAl6V4 [cast alloy], TMZF, pure titanium [c. p. 1] and iodide titanium were analyzed for the presence of the elements that have been associated with allergic reactions using spectral analysis. All the implant material samples contained traceable amounts of Be, Cd, Co, up to a maximum of 0.001 percent by weight [wt.%], Cr up to 0.033 wt.%, Cu up to 0.007 wt.%, Hf up to 0.035 wt.%, Mn up to 0.007 wt.%, Ni up to 0.031 wt.%, and Pd up to 0.001 wt.%. This paper demonstrates that all the investigated implant material samples contained a low but consistent percentage of components that have been associated with allergies. For example, low nickel contents are related to the manufacturing pro- cess and are completely dissolved in the titanium grid. Therefore, they can virtually be classified as “impurities”. Under certain circumstances, these small amounts may be sufficient to trigger allergic reactions in patients suffering from the corresponding allergies, such as a nickel, palladium or chrome allergy.

Exenatide promotes regeneration of injured rat sciatic nerve

Damage to peripheral nerves results in partial or complete dysfunction. After peripheral nerve injuries, a full functional recovery usually cannot be achieved despite the standard surgical repairs. Neurotrophic factors and growth factors stimulate axonal growth and support the viability of nerve cells. The objective of this study is to investigate the neurotrophic effect of exenatide （glucagon like peptide-1 analog） in a rat sciatic nerve neurotmesis model. We injected 10 [ag/d exenatide for 12 weeks in the experimental group （n = 12） and 0.1 mL/d saline for 12 weeks in the control group （n = 12）. We evaluated nerve regeneration by conducting electrophysiological and motor functional tests. Histological changes were evaluated at weeks 1, 3, 6, and 9. Nerve regeneration was monitored using stereomicroscopy. The electrophysiological and motor functions in rats treated with exenatide were improved at 12 weeks after surgery. Histological examination revealed a significant increase in the number of axons in injured sciatic nerve following exenatide treatment confirmed by stereomicroscopy. In an experimentally induced neurotmesis model in rats, exenatide had a positive effect on nerve regeneration evidenced by electromyography, functional motor tests, histological and stereomicroscopic findings.

Effect of Skin Pigmentation on Near Infrared Spectroscopy

The purpose of this study was to determine the effects of skin pigmentation regarding Near Infrared Spectroscopy (NIRS) tissue oxygen saturation values (StO2). The study examined NIRS values in individuals with varying skin pigmentation on the anterior compartment of the lower leg and volar forearm to determine if correlation exists among three NIRS devices, the EQUANOX, Casmed, and INVOS. Skin pigmentation was measured on the anterior lower leg (AL) and volar forearm (VF) of participants using a noninvasive colorimeter that employed reflective spectroscopy to produce a quantitative value for erythema (skin “redness”) and melanin (skin pigment). Muscle oxygenation was measured using three oximetry devices with sensors placed in the same areas. The EQUANOX device showed no significant correlation with skin pigmentation, while the Casmed and INVOS devices showed moderate and significant correlation with skin pigmentation, respectively. Different devices have different abilities to remove confounding variables, such as skin pigmentation and erythema, which may affect clinical decision-making, and affect the use of NIRS technology.

Rheumatoid Arthritis with High Serum KL-6 Complicating Malignant Tumor: Two Case Reports

Interstitial pneumonia develops not only as a rheumatoid arthritis (RA) manifestation, but also due to the side effects of drugs for its treatment, leading to the necessity of regular examinations. Krebs von den Lungen-6 (KL-6) is often used to check the activity of interstitial pneumonia in RA patients. However, this marker is also produced by some malignant tumors, and a high level of serum KL-6 has been reported in cancer patients. We describe herein 2 cases of RA with the complication of a malignant tumor not involving the lung, although there is no lesion in the lung regardless of the high level of serum KL-6.

Patient-specific instruments as a standard procedure in total knee arthroplasty: Logistics and postoperative radiological results in 70 patients

Serous Purpose: There is limited information in the literature surrounding the use of patient-specific instrumentation (PSI) by a large number of surgeons. This prospective observational study was therefore designed to evaluate the logistics of using PSI for total knee arthroplasty (TKA) in a multi-surgeon environment, as well as its accuracy in positioning components. Methods: Of 73 patients enrolled in this study, 3 were excluded after the surgeon decided intraoperatively to switch to conventional instrumentation. Results: Mean operative time was 77.6 minutes. The component size had to be changed in 19 patients and bone cuts corrected in 12. In 65 of the 70 cases (92.9%), mechanical alignment was within the optimal range from 3° varus to 3° valgus, with the remaining 5 cases considered outliers (7.1%). Mean overall mechanical alignment was 0.3° varus (standard deviation, ±2°). There was a distinct variance with regard to the position of the tibial component in the sagittal plane. Conclusions: PSI can be effectively incorporated in larger, multisurgeon practices. Although high accuracy was observed for overall mechanical alignment and component positioning in the frontal and sagittal planes, further attention must be paid to the tibial slope. We highly recommend the use of the extramedullary alignment rod to the proper position of the tibial block, as well as double-checking the slope before performing bone cuts.

FRAX and Exercise: Should Exercise Be Categorized as a Risk Factor in Osteoporotic Patients

Although FRAX (WHO Fracture Risk assessment Tool), developed by the WHO, is a well-validated tool for determining the probability of a major osteoporotic fracture in the next 10 years, it doesn’t include a number of other impact factors such as exercise and nutrition. The purpose of this study was to compare the differences in FRAX between subjects with and without exercise habits or intake of calcium/coffee. A significant difference in FRAX was observed between the groups with respect to exercise (p < 0.001). There were no significant differences in FRAX, however, between the groups with and without intake of calcium/coffee. Although exercise habits are not included in FRAX, our findings suggest that exercise status influenced other factors included in FRAX. Since exercise is reported to prevent falls and fall-related osteoporotic fractures, including exercise status in FRAX may be more effective for estimating the possibility of future fractures. Further investigation should be conducted to determine whether exercise status is an important risk factor, independent of FRAX, for osteoporotic fractures.

Integrity of the hip capsule measured with magnetic resonance imaging after capsular repair or unrepaired capsulotomy in hip arthroscopy

BACKGROUND Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy.Regarding patient reported outcome measures there seems to be no difference between capsular repair or unrepaired capsulotomy.AIM To evaluate and compare the integrity of the hip capsule measured on a magnetic resonance imaging(MRI)scan after capsular repair or unrepaired capsulotomy.METHODS A case series study was performed;a random sample of patients included in a trial comparing capsular repair vs unrepaired capsulotomy had a postoperative MRI scan.The presence of a capsular defect and gap size were independently evaluated on MRI.RESULTS A total of 28 patients(29 hips)were included.Patient demographics were comparable between treatment groups.There were 2 capsular defects in the capsular repair group and 7 capsular defects in the unrepaired capsulotomy group(P=0.13).In the group of patients with a defect,median gap sizes at the acetabular side were 5.9 mm(range:2.7-9.0)in the repaired and 8.0 mm(range:4.5-18.0)in the unrepaired group(P=0.462).At the muscular side gap sizes were 6.6 mm(range:4.1-9.0)in the repaired group and 11.5 mm(range:3.0-18.0)in the unrepaired group(P=0.857).The calculated Odds ratio(OR)for having a capsular defect with an increasing lateral center-edge(CE)angle was 1.12(P=0.06).The OR for having a capsular defect is lower in the group of patients that underwent a labral repair with an OR of 0.1(P=0.05).CONCLUSION There is no significant difference in capsular defects between capsular repair or unrepaired capsulotomy.Regarding clinical characteristics our case series shows that a larger CE angle increases the likelihood of a capsular defect and the presence of a labral repair decreases the likelihood of a capsular defect.